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New Hampshire rates for HCPCS L5665

Addition to lower extremity, socket insert, multidurometer, below knee (BK)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.09 / $457.09 / $549.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $398.11 / $549.54
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.76 / $891.25 / $1,023.29
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $371.54 / $389.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.09 / $457.09 / $602.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $331.13 / $457.09
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $724.44 / $1,258.93
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.55 / $416.87 / $489.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $436.52 / $724.44
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.31 / $741.31 / $1,174.90